Revenue Cycle Insider

Question: I read “Use This Advice for Dx Sequencing for a Viability Ultrasound in an AMA Pregnancy” in the May 2026 Revenue Cycle Insider, and I had a question:

How should I approach sequencing diagnosis codes? I’m new to coding, and I’m unsure where to start when multiple codes are needed.

Texas Subscriber

Answer: When you’re unsure how to sequence diagnosis codes, don’t start with the codes. Start with the clinical story of the encounter.

Your job is to identify what the provider is actually treating, evaluating, or managing during that visit. The primary diagnosis is not necessarily the “most serious” condition or the most specific code available; it is the condition that best explains why the patient is being seen that day.

If more than one diagnosis is documented, think in terms of hierarchy:

• What prompted the visit?
• What is actively being evaluated or managed right now?
• What condition is driving the medical decision making for this encounter?

Everything else becomes secondary, even if it is clinically important or chronic.

You should also be careful not to let habit drive sequencing. Common traps include defaulting to:

• Chronic conditions first,
• Screening codes first, or
• “Rule-out” impressions first.

Instead, you should always return to documentation and ask: What is the provider’s focus today?

Finally, remember that sequencing is not just a coding exercise. It directly impacts medical necessity, claim adjudication, and patient financial responsibility. When in doubt, aligning sequencing to the documented reason for the encounter is the most defensible approach you can take.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor